Medical management of adult glioma

Abstract

Initial medical management of glioma will depend on distinguishing symptoms related to the direct effects of the tumour, from those that are secondary to the stress or recurrence of a pre-existing psychological illness, and symptoms that are related to medication. The cause of symptoms may vary with time, e.g. headache from raised intracranial pressure to post-craniotomy headache or migraine; therefore the history should be revisited regularly to ensure the most effective treatment is prescribed. Prevention of perioperative complications, e.g. deep vein thrombosis and pulmonary embolus or post-operative seizures, may complicate the management. Care must be taken to minimise medication that may interact with future treatment or produce neurological side effects. During oncological therapies medical management may involve reducing unnecessary treatment and consolidating support and advice, e.g. on management of epilepsy, treatment of mood disorders and diagnosis and management of ongoing or new symptoms such as headache, seizures, spasticity, bladder problems and fatigue. Neuro-rehabilitation and neurocognitive rehabilitation should be established as early as possible after initial surgery. Late effects of treatment become an issue in long-term survivors depending on the radiation therapy dose and volume. Late effects may produce episodic disturbances related to vascular, epileptic or metabolic disturbances or a progressive neurocognitive and physical decline that usually requires more complex packages of supportive and palliative care. Endocrine effects from radiation on the pituitary gland are reversible. In late stages of illness, good symptom management is the difference between a peaceful death and a stressful memory that will live with the family forever.